All ETDs from UAB

Advisory Committee Chair

Elizabeth J Richardson

Advisory Committee Members

Leanne R Cianfrini

Burel R Goodin

David C Knight

J Scott Richards

Document Type

Dissertation

Date of Award

2015

Degree Name by School

Doctor of Philosophy (PhD) College of Arts and Sciences

Abstract

While spinal cord injury (SCI) is a relatively rare in the general population, it has significant implications on functionality, independence, and quality of life for individuals who are affected by it. Common sequelae of SCI include sensorimotor dysfunction and pain symptoms that are often severe. More specifically, approximately 33% of individuals with SCI experience severe, intractable neuropathic pain. Additionally, treatments for neuropathic pain have variable efficacy and/or many side effects. While SCI-related neuropathic pain is thought to be related to cortical reorganization and nerve damage, there may be psychological factors that contribute to increased pain severity and variable treatment response. While treatment of neuropathic pain is limited by the current knowledge base, evaluation of existing treatments and development of novel treatments continues. Within that framework, the present study examined psychosocial factors including emotion regulation in relation to pain severity and treatment efficacy during a randomized controlled trial for a novel, visual feedback treatment for SCI-related neuropathic pain. Fifty individuals with spinal cord injury were recruited for a one-day trial of the visual feedback treatment. A mixed linear model examining factors related to pain change found no significant predictors. Specifically, emotion regulation did not statistically predict treatment response or moderate the relationship between treatment condition and pain reduction. Five individuals with SCI were recruited for a two-week trial of the visual feedback treatment where functional magnetic resonance imaging (fMRI) data were collected during viewing of the treatment stimuli to examine differences in cortical activation within the SCI sample and between the SCI sample and a sample of able-bodied controls who underwent the same imaging during a pilot study. Examination of mean differences in pain was not calculated secondary to small sample size. There were no differences between treatment stimuli within the SCI sample. Activation differences between able-bodied controls and the SCI sample in brain areas associated with emotional evaluation including the insula. These early results suggest that the treatment is more emotionally activating for individuals with SCI versus able-bodied controls. This difference in emotional responding may be related to variable response to treatment of neuropathic pain seen in individuals with SCI.

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